Reaching out – Improving heath in remote communities
Reaching out – Improving heath in remote communities
Approximately 273,273 or 1 in 3 children aged five or under are stunted (low height for age) in Laos. The national average obscures the reality of a deep urban-rural divide, which deepens for those living in the most remote areas of the country. UNICEF supports the Government of Laos to bridge this urban-rural gap by strengthening health outreach services. Under the broad Partnership for Improved Nutrition, a multi-donor action supported by the European Union, UNICEF Australia and MMG, outreach activities for maternal, infant, young child health and nutrition have been scaled up. Because of the support provided under the Partnership for Improved Nutrition, there has been improved governance for nutrition planning, monitoring and reporting on progress. Health care staff and community-based volunteers also have improved skills and knowledge to support the implementation of nutrition services. Healthcare staff and community-based volunteers are now able to provide nutrition services to remote communities that otherwise would not have been able to access services at fixed sites such as hospitals or health centres.
Despite a decrease in the total number of children stunted in Laos, the provincial differences are cause for concern. The total number of children wasted has increased. Wasting is a life-threatening form of undernutrition, that if left untreated, can result in death. Outreach activities supported under PIN have made it possible for healthcare providers and community-based volunteers to actively look for children who are wasted by measuring their height, weight and mid-upper arm circumference.
The involvement of community-based volunteers has been crucial for expanding the reach of essential nutrition services to remote villages, for disseminating key behaviour change messages about infant and young child feeding and for supporting mothers and caregivers to adopt recommended care practices. The first 1,000 days of a child’s life is a critical time to ensure they are getting adequate nutrition for healthy development. Ms. Kahan who lives in a nearby village, is demonstrating how to cook a nutritious meal from locally available food and how to add Superkid, a micronutrient powder, to boost the nutrient content of the meal. Malnutrition and sickness in her community are what first drove her to volunteer to teach others. “I wanted to learn how to cook healthy food. I’d seen lots of malnourished children in my village and to learn how to cook balanced meals with protein and local vegetables was important.” Kahan goes on to explain that not all families know how and what to cook, even when food is plentiful. “Even though families might have the ingredients, they don’t know how to cook. They just weren’t putting in the nutrition they could.”
This year, the health outreach activities are ensuring families receive information and counselling that they need to maintain optimal breastfeeding practices, that they need to understand how nutrient content of children’s meals are increased and what the consequences of not washing hands with soap can have on infants and young children. The investments made to improve the capacity of healthcareworkers and village health volunteers is having a positive impact. For 25-year old Leum and her two small boys, this has proved to be the most crucial health intervention they have experienced. “I didn’t know that my children were malnourished until the outreach workers came to the village. The health workers measured my boys’ height and around their arms. They also told me about the type of food I should cook for them,” she says as she cools a spoonful of fortified rice soup and feeds it to her youngest son. “Before my children were always sick. They were tired and often had diarrhoea. Since the health workers have come and taught us better ways to care for our children, they don’t get sick anymore.”
Phetsamay Thepsombath has been leading outreach programmes for eight years and has seen improvements in the village first hand. Today he is overseeing vaccinations and nutrition screening. “There are more outreach programmes now, and coverage is increasing. The involvement of volunteers and the training available to health workers has helped us to be a lot more effective. We see a lot less malnutrition than we did in the past. Through vaccination and health messages in many of the villages we work in, we would see eight or so deaths a year, and now we don’t see any.”
Capacity-building efforts not only focus on the district and community level but go up to provincial and national levels. It is clear to Phetsamay how efforts to strengthen health sector capacity has changed processes at all levels. “There is much better communication between the health department, local authorities and communities now. We used to have trouble accessing villages just because the permission wasn’t there. But now we cooperate with different authorities, and the communities are happy for us to come. “Phetsamay gestures as Kahan’s cooking demonstration gets underway. “We couldn’t do this without everyone involved. From the village health volunteers to the provincial health department.”
The village children gather around Ms. Kahan as she cooks, eagerly waiting their turn as she ladles the hot rice porridge with added Superkid into their bowls. The children’s favorite part of the outreach programme is a delicious and nutritious lunch.